AB1560-HPR NURSE-DRIVEN DIAGNOSTIC PROCESS OF PATIENTS WITH SJÖGREN’S SYNDROME (SS) A CLINICAL DEVELOPMENT PROJECT
Authors: M. T. Poder, G. M. Colding, K. Frödin, M. B. T. Pedersen, M. S. Andersen, L. S. Timm, A. Vibe, K. N. Sørensen, L. Lindgren, A. Svensson, M. Pfeiffer-Jensen, V. Fana, J. J. Lykkegaard, G. Thamsborg
Journal: Annals of the Rheumatic Diseases (2022)

Background Sjögren’s Syndrome (SS) is a chronic autoimmune disease that affects the body’s glandular functions, especially the lacrimal and salivary glands, causing the mucous membranes to dry out (1). There are no diagnostic criteria, and classification criteria are often used to support the diagnosis (2). We identified a need to unify and consolidate the diagnostic process of patients with SS in the Capital Region of Denmark. A medical working group supervised the nurse-driven diagnostic process at Rigshospitalet, Glostrup. Here an interdisciplinary working group with physicians, nurses, and secretaries developed a diagnostic process and logistic based on the American-European Consensus Group Classification Criteria 2002 (3). The nurse’s took medical history and performed sicca tests and made sure that the patient received adequate guidance. With input from three patients, the nurses at the outpatient clinic developed - written material on eye and mouth dryness. We developed a “smart phrase” for our documentation platform in the interdisciplinary working group. The purpose of the ‘smart phrase”, was to unify the documentation and ensure continuity in the conversation with the patient. The Rheumatologists task was to disprove or confirm the diagnosis and perform a risk stratification especially in relation to the development of lymphoma, but also interstitial lung disease. Objectives The aim of this project was to examine and evaluate the patients’ experience of nurse-driven diagnostic process. Methods To evaluate the new patient course, we performed a survey. The questions selected for the survey were primarily based on the patients experience of meaning and coherence in the diagnostic process. The questions were developed by the nurses in the Outpatient Clinic; “Do you feel safe going home after the consultation today?” “Did you get answers to the questions you asked while you were in the consultation?” “Did the staff take the time to listen to you?”. Also, the patients could add comments. Results A total of 34 consecutives responded to the questionnaire. 88% felt safe when returning home from the Outpatient Clinic, 85% received answers to their questions during the consultation. Altogether, 94% answered that the health care professionals were present and listened to them. The patients had the following comments: “The diagnostic process contained a lot of unresolved waiting time “ and “There has been some confusion about the division of tasks in the different hospital wards”. Conclusion We found that the patients were satisfied with the nurse-driven diagnostic process. The diagnostic process created a feeling of safety in the patients and the patients found that they were listened to and allowed to ask questions. In addition, by evaluating the process investigation, we could change practice and further unify the diagnostic process. The result of the questionnaire supports the justification of the nurse competencies, by preforming a high level of information and guidance as well as the need for recognition of the patient’s symptoms. Therefore, the working group chose to meet again and evaluate. We decided that the nurse and rheumatologist consultation should be performed on the same day. Such consultation made it possible for the nurse to ensure continuity in the process, as the same nurse could follow the patient throughout the day. This optimized the opportunity for the nurse to guide the patient in the symptomatic treatment of eye and mouth dryness. Also, the nurse had the opportunity to guide in oral hygiene, fatigue, and lifestyle factors. The next step in our development project is to evaluate our revised nurse-led diagnostic process. In addition, the working group is currently working on material for a course in SS, where 4-6 patients and relatives can have the opportunity to participate. References [1]A.Voss et al. Reumatologi. FADL’s Forlag 2018. 238-251 [2]Troldborg, A et al. National behandlingsvejledning, Sjögrens syndrom. 2020. [3]Troldborg, A et al. Sjögrens Syndrom, Dansk Reumatologisk Selskab 2010. Acknowledgements I would like to thank the patients for the contribution to this project. Disclosure of Interests None declared